And I’m one of them. So I have always put off screening, getting Pap tests – which screen for cell changes in the cervix that can lead to cancer – every couple of years, usually as part of my prenatal or postpartum care.
When I had an abnormal Pap result late last year, I didn’t think too much of it. I’d had abnormal Paps a few times in my 20s, but had always come up clear in future tests.
So I was shocked to learn, after a colposcopy, biopsy, and LEEP procedure, that my abnormal cells had actually developed into invasive cervical cancer.
I’ll be OK – the cancer is at a very early stage, 1a – but I will need to have a hysterectomy early next week to prevent the cancer spreading further into my cervix and uterus.
To say the least, I was shocked when I got the news from my doctor. How could this happen?
I couldn’t remember ever having been tested for HPV, or Human Papilloma Virus, but my doctor told me that cervical cancer is almost always caused by HPV…in my case, probably one of the nastier, faster-moving kinds.
As a busy mom, I admit that over the last decade or so I got the majority of my well-woman care and screening in the context of pregnancy and childbirth. We moved several times, so I saw a few different practices, and didn’t do the best job keeping track of what I’d learned and when. The way I figured, once I got a negative Pap, I was in the clear!
But that’s not quite how it works. I’ve learned quite a bit about HPV, Pap smears and cervical cancer over the last few stressful months, and I want to share some of what I’ve learned with you:
1) HPV is incredibly common. If you have it, it doesn’t mean you’ve been promiscuous! According to the National Cancer Institute, the majority of both men and women will be infected with HPV at some time in their lives, and that may be true even if you’ve only had one sexual partner. In fact, a 1997 article in the American Journal of Medicine, reported that nearly 3 out of every 4 Americans has been infected with HPV at some point in their lives.
While HPV is a sexually-transmitted disease, it can be transmitted via non-intercourse sexual contact. So it’s even possible to be a virgin and have HPV.
2) Some HPV infections resolve themselves, but others can “hide” in the body. So for example, you could get HPV the very first time you have sex, but then it could go undetected for years. And while some strains of HPV can cause warts on the genitals, hands, or feet, many show no symptoms at all, and this includes several of the aggressive, cancer-causing variety.
After the abnormal Pap I had last winter, my health care provider suggested that my husband was having an affair because I “suddenly” had HPV!! But when I dug into the research, I found that an HPV infection can lie dormant for many years and it does not indicate that your spouse has been unfaithful. (Needless to say, I left that practice!)
There is no need for blame or guilt when dealing with the already-stressful circumstance of finding out you have or had HPV. It’s so common that it would be more surprising to learn that you and your spouse had not ever had it.
3) Pregnancy and childbirth can cause cervical changes that alter the results of a Pap smear. The tissue trauma cased by childbirth can lead to false positive or inconclusive Pap smear results, but it can go the other direction, too. For over a decade, my Pap smears followed a predictable pattern: I’d have an abnormal Pap while pregnant (usually the results came up as ASCUS, or “atypical squamous cells of unknown significance”), but then at my six-week checkup, I’d get the all-clear.
Several health care providers told me that the process of labor and birth can “slough off” the abnormal cells on the surface of the cervix, possibly leading to my negative postpartum Paps.
But it’s also possible that, below the surface, the abnormal cell changes were still happening (and the HPV infection that was causing them had not gone away.) Since I was having babies every 2-3 years, and got the majority of my screening either during pregnancy or immediately postpartum, I was never really screened during a ‘normal’ time.
When you’re in the baby-making phase of life it’s easy to get into the routine of scheduling your routine checks around your pregnancies and postpartum visits, but if I had it to do over, I’d schedule a follow-up Pap at least 6 months after giving birth to make sure my “negative” result was real.
4) Having many children can make a recurrent HPV infection more likely. So can cigarette smoking, using oral contraceptives for many years, and anything that taxes the immune system. If you fall into one of these groups it’s even more important that you get regular screening!
5) Dysplasia and “carcinoma in situ” – cancerous cells that are still on the surface of the cervix – can often be treated in a way that preserves fertility. In my case, because the cells had begun to invade the cervix, hysterectomy is the recommended treatment (and, fortunately, my family is complete.) But had my case been less developed, the LEEP procedure would likely have taken care of it for good. Cone biopsy and cryosurgery are two other options for treatment of cervical dysplasia that still allow for future pregnancies.
6) Guidelines have recently changed. You might have read about the recent new guidelines that suggest spacing out Pap tests in healthy women with clear backgrounds from yearly to once every 3-5 years.
Personally I have some issues with these new guidelines, as I think it’s easy for important information to fall through the cracks if you change practices or have several babies in a row. It’s already so easy to “put off” important testing when you’re busy with kids at home, and changing the guidelines to once every three years seems to me to indicate a lack of urgency that might make it even easier for women to delay the test.
False negative tests are a possibility and during that three-year period, abnormal cell changes could be happening undetected. Also, while most cervical cancers are slow-growing, there are some forms of cervical cancer that move much faster.
All that is to say that I think you need to be assertive about your own health. If after reviewing your history with your health-care provider you feel that a Pap every 3 years is sufficient, by all means, stick with that plan.
But don’t blindly follow a “once every 3 years” plan without discussing your history and worries with your doctor or midwife. If you change practices, don’t rely on your memory of your previous Paps to relate to your new care provider – get your records. While I technically did what I was supposed to do – getting Paps every 2-3 years – in reality, I could and should have been much more aggressive.
And the way I see it, paying out of pocket for an annual Pap would have been totally worth it if it meant I got to avoid surgery.
Overall, be sure your regular “self-care” includes the important stuff like health screenings and tests for yourself, and not just your family. After all, the greatest gift we can give ourselves – and our kids! – is a healthy Mom.
For more information on HPV and cervical cancer, please visit the Cervical Cancer Page at Cancer.gov.
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